Trial by Self-Assessment

June 30, 1995. At home in my study.

I am taking the day off from practice to beat the deadline. In a final spasm of work, I have just completed and prepared for mailing my answer sheets for the final section of the formidable triennial self-assessment program offered by my professional society. For me and several thousand of my fellow internists, the nightmare from school days has come true once again: Turn in your exams, ready or not, time is up. I ought to feel nothing but satisfaction and relief, but having to use one of my precious vacation days for hard study has undermined my triumph and fueled my growing resentment of this exhausting ordeal.

Self-assessment has been an intellectually exhilarating process and an ego-deflating revelation of my deficiencies, particularly in human immunodeficiency virus disease, oncology, and genetics. Remembering both the brand and generic names of antibiotics is simply beyond my capacity. But what a feast for the mind it has been. The surprisingly low high-density lipoprotein levels found in my muscular weightlifting friend are a giveaway that he is taking anabolic steroids; no comfort can be found in drinking comfrey tea, because it may cause venoocclusive liver disease; the C-reactive protein test is a less cluttered indicator for acute phase reactants than is the sedimentation rate; and the ominous lymph node on my grandson's arm was probably caused by Rochalimaea henselae-the bacillus that causes bacillary angiomatosis in the patient with the acquired immunodeficiency syndrome-introduced by a scratch from a neighbor's cat. What's more, I have conquered allele angst, and I can now smile knowingly when the residents spout out terms like BOOP, C- or P-ANCA, and E. coli O157:H7. Truly, nothing so captivates the mind as new knowledge, but I find no …